NATO ADVANCED TRAINING COURSE Integrated Emergency...

NATO ADVANCED TRAINING COURSE

Integrated Emergency Management for

Mass Casualty Emergencies

UNIVERSITA’ DEGLI STUDI DI FIRENZE

Wednesday 26th

to Saturday 29th

October 2011

Venue: Villa La Quiete alle Montalve, via di Boldrone 2, 50141, Florence, Italy

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ORGANISERS

Prof. David Alexander

Professor, CESPRO, University of Florence

Largo Brambilla H3

50134 Firenze, Italy

Tel: 0039 333 432 8832

Fax: 0039 055 412862

Email: [email protected]

Mr Chaim Rafalowsky

EU Projects and Disaster Management Coordinator

Magen David Adom in Israel (Red Cross Affiliate)

60 Yigal - Alon Street

67062 Tel Aviv, Israel

Tel: 00972 3 630 0222 / 2281

Fax: 00972 3 631 2215


SCIENTIFIC COMMITTEE

Prof. David Alexander, University of Florence, Italy, Chairman

Mr Chaim Rafalowsky, Magen David Adom in Israel, Co-Chairman

Prof. Emanuela Masini, Director, CESPRO, University of Florence, Italy

Prof. Rosa Valanzano, President of the Degree Course in Medicine and Surgery, University of

Florence, Italy

Prof. A. Raffaele De Gaudio, University of Florence, Italy

Prof. Sergio Boncinelli, CESPRO, University of Florence, Italy

Dr Alessandra Rossodivita, San Raffaele Hospital, Milan, Italy

Dr Eric Noji, Consulting Medical Epidemiologist & former Chief International Emergency &

Refugee Health Program, Centers for Disease Control and Prevention (CDC), USA

Mrs. Laura Mugnai, University of Florence, Italy

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P R O G R A M M E OF S T U D I E S

First day – Wednesday 26th

October 2011

08:00-08:30 Registration

08:30-10:00 Inaugural speeches

GIAN FRANCO GENSINI

Dean of the Faculty of Medicine and Surgery, University of Florence

ALBERTO TESI

Rector of the University of Florence

PAOLO PADOIN

Prefect of Florence

DANIELA SCARAMUCCIA

Regional Councillor responsible for Healthcare

Integrated perspectives on emergency response: introduction and principles

10:00-11:00 A global perspective on integrated emergency response

David Alexander, University of Florence, and Chaim Rafalowsky, Magen David

Adom in Israel

11:00-11:30 Coffee break

11:30-12:30 An emergency planning and management perspective

David Alexander, University of Florence

12:30-13:30 A training perspective

Chaim Rafalowsky, Magen David Adom in Israel

13:30-14:30 Lunch break

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Planning integrated responses to major events in the future: national and

local perspectives

14:30-15:30 Clinical risk Management in mass-casualty events

Francesco Venneri, Clinical Risk Manager, Azienda Sanitaria 10 Firenze, Italy


16:00-17:00 Classroom exercise and discussion on integrated response to hazards

David Alexander and Roberto Miniati, University of Florence

17:00-17:30 Brief tour of the emergency management facilities, City and Province of

Florence

David Alexander, University of Florence, Luigi Brandi, in charge of Civil

Protection Office City of Florence, and Colleagues

18:00-19:30 Reception for speakers and foreign delegates

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Second day – Thursday 27th

October 2011

Planning integrated responses to major events in the future: domestic and

international perspectives

09:00-10:00 Integration of medical response with other aspects of assistance

Divide Colombo CRIMEDIM - University of Eastern Piedmont, Italy

10:00-11:00 The role of Hospital in the international disaster response

Pierluigi Ingrassia, CRIMEDIM - University of Eastern Piedmont, Italy


11:30-12:30 Optimal fluid administration in emergency situations

A. Raffaele De Gaudio, University of Florence, Italy


13:30-14:30 Mass casualty fluxes and patient care issues in disasters

Jeffrey Arnold, Santa Clara Valley Medical Center, USA

14:30-15:30 Medical system integrations and the hospital response to mass casualty

events

Alessandra Rossodivita, San Raffaele Hospital, Italy


16:00-16:45 Civil-military collaboration and integrated response

Eric K. Noji, CDC, USA

16:45-17:30 Integrating humanitarian operations

David Alexander, University of Florence, Italy

20:00-22:00 Conference dinner (individual payment)

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Third day – Friday 28th

October 2011

Integration of response to hazards and crises

09:00-10:00 Mortality and morbidity scenarios for natural hazards and associated

response needs

Eric Noji, CDC, USA

10:00-11:00 Medical system integrations and the hospital response to mass casualty

events

Jeffrey Arnold, Santa Clara Valley Medical Center, USA


11:30-12:30 Hospital response and natural disasters

Roberto Miniati, University of Florence, Italy


13:30-14:30 An integrated response to terrorism incidents: intelligence, civil defence and

emergency response

Eric Noji, CDC, USA

14:30-15:00 Integrated response to CBRN mass-casualty events

Emanuela Masini, University of Florence, Italy

15:00-15:30 Nuclear Approach

Antonio Santoro, Army Medical Corps- Brigade general, Italy


16:00-17:00 Pandemic emergency planning: medical and non-medical approaches and

their integration

Alessandra Rossodivita, San Raffaele Hospital, Italy

17:00-17:30 Medical students as a new resource in hospital mass-casualty events

Marco Mangini and Francesco Grossi, University of Florence, Italy

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Fourth day – Saturday 29th

October 2011

Case histories and lessons to learn

09:00-09:45 Emergency medical management in the 2004 Madrid train bombings

Alejandro Lopez-Carresi, Madrid

09:45-10:30 Analysis of the 2009 Earthquake of L’Aquila, Italy

Massimo Casacchia, University of L’Aquila, Italy

10:30-11:15 Analysis of the 2005 London bombings

David Baker, Health Protection Agency, UK


11:45-12:30 Integration of responses to the Polonium poisoning incident in London

David Baker, Health Protection Agency, UK

12:30-13:30 Discussion

13.30-14.30 Lunch Break

14-30-17.00 Interactive Didactics:

“Auxilium” Simulation game

designed by Luca Gorrone, Police Officer, Prato

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SPECIALISTS

1. DAVID ALEXANDER (as above)

2. CHAIM RAFALOWSKY (as above)

3. JEFFREY ARNOLD Emergency Department Chairman

Santa Clara Valley Medical Center

San Jose, California

460 Twin Pines Drive, Scotts Valley, CA 95066, USA

Tel: 001 408-885-2334 (office)

Mobile: 001 831-707-4746 (mobile)


[email protected]

4.DAVID BAKER M Phil DM FRCA FRSM

Consultant Medical Toxicologist

Extreme Events and Health Protection

Centre for Radiation, Chemicals and Environmental hazards

Health Protection Agency 2nd Floor,

Buckingham Palace Road

London SW1W 9SZ, Great Britain

Tel: 0044 207 881 7143

Mobile: 0044 7816 893 705


5. MASSIMO CASACCHIA Psychiatric Clinic

Nuovo Ospedale Regionale Coppito

67010 L’Aquila, Italy

Tel: 0039 0862311713


6. DAVIDE COLOMBO MD PhD Anaesthesia and Intensive Care

Department of Clinical and Experimental Medicine

CRIMEDIM Center for Research in Emergency and Disaster Medicine and simulation

applied to medical teaching - University of Eastern Piedmont

Maggiore della Carità University Hospital

Mobile: 0039 347 4111760

Fax: 0039 0321660620


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7. ANGELO RAFFAELE DE GAUDIO Director of the Post-graduated school of Anaesthesiology and Intensive Care

Department of medical and surgical critical care.

University of Florence

Viale Morgagni, 85


Tel: 0039 055 434807 - 4277633

Fax: 0039 055 430393


8. LUCA GORRONE Police Officer

Immigration Office, Questura di Prato

via Migliore di Cino, 10

59100 Prato, Italy

Tel: 0039 0574-5551;

0039 0574-555610

Fax: 0039 0574-555600


9. FRANCESCO GROSSI Post-graduated school of Cardiology

Viale Morgagni, 85

50134 Firenze

University of Florence, Italy

Tel: Francesco Grossi 0039 3398427864


10. PIERLUIGI INGRASSIA CRIMEDIM

Center for Research in Emergency and Disaster Medicine and simulation applied to

medical teaching - University of Eastern Piedmont

Department of Experimental and Clinical Sciences

Novara, Italy

Fax: 0039 0321 373 3406


11. ALEJANDRO LOPEZ CARRESI Director of CEDEM

Centro de Estudios en Desastres y Emergencias

C/Hileras 4

28013 Madrid, Spain

Website: www.cedemformacion.com

Tel: 0034 91 758 63 86

Email: [email protected] ; [email protected]

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12. MARCO MANGINI Post-graduated school of Anaesthesiology and Intensive Care


Viale Morgagni, 85


Marco Mangini

Tel: 0039 338 4286123


13. EMANUELA MASINI Professor and Director, CESPRO

Department of Preclinical Pharmacology


Viale Pieraccini 6


Tel: 0039 055 427 1233

Fax: 0039 055 427 1280


14. ROBERTO MINIATI Engineer, Researcher, CESPRO


Largo Brambilla H3


Tel: 0039 328 601 7001

Fax: 0039 055 412862


15. ERIC K. NOJI MD, MPH, DTM&H (Lon)

Consulting Medical Epidemiologist & Former Chief of International Emergency & Refugee

Health Program

Centers for Disease Control and Prevention (CDC)

Direct: 001 202 407 91 25

Mobile tel: 001 703 634 35 08

1901 Pennsylvania Ave, NW Suite 700

Washington, DC 20007, USA

Website: http://eknoji.com

Email: [email protected]; [email protected]

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16. ALESSANDRA ROSSODIVITA San Raffaele Hospital Scientific Foundation

Head of Semi – Intensive Cardiac Surgery

Department of Cardiothoracic and Vascular diseases

Member of Maxy – Emergency Commitee

University of Medicine “Vita – Salute”.

Via Olgettina 60

20132 Milano, Italy

Tel: 0039 02 2643 7532

Fax: 0039 022 64 37 125.

Email: [email protected], [email protected]

17. ANTONIO SANTORO Italian Army Medical Corps-Brigade general

CBRN Medicine Expert

Florence branch c/o D.M.M.L. of Florence

Via Venezia, 5


Tel: 0039 055 582615

Mobile: 0039 338 5056788


18. FRANCESCO VENNERI Azienda Sanitaria 10 Firenze

Legal seat: Piazza Santa Maria Nuova


Mobile: 0039 339 8369969


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NATO ADVANCED TRAINING COURSE

Integrated Emergency Management for Mass Casualty Emergencies

Florence, Italy, 26th-29th October 2011

The essence of good emergency management is to ensure the efficient deployment

of resources in the light of immediate and pressing needs. This requires effective co-

ordination of a wide variety of organisations and agencies which either do not normally work

together or seldom do so under the particular conditions of an emergency situation. Rescue,

triage, medical care in the field and in trauma centres, transportation and logistics,

epidemiological monitoring, disease control, the maintenance of public health, toxicological

testing of dangerous conditions, and so on, all require concerted action by a broad spectrum

of forces.

Such is the wide variety of political and administrative systems in different countries

that there will probably never be a standard or universal system of civil protection (i.e., of

emergency management). However, there is a pressing need for greater international

collaboration. This exists in part because the threats posed by terrorism, epidemics and

climate change are likely to create more trans-national disasters in the future. It also reflects

a common and well justified desire to collect, share and utilise information on the

experience of managing emergencies in other countries. Finally, there are common

principles of emergency management and they need to be debated, refined and shared.

Hence, we should be moving towards a system in which there is a common culture of civil

protection and a sense of shared values and procedures. This can be achieved in significant

measure by sharing knowledge through advanced training. The process will not impede

national and regional developments but should instead enable systems to be designed that

achieve the best possible fit with local conditions. The course will also enable practitioners

and lecturers to share best practices and lessons learned from different countries, situations

and environments in the emergency medical response field.

Emergency planning should be a participatory process that facilitates collaboration.

Generally, individual organisations have their own procedures and protocols for responding

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to crises and emergencies, but the weak points are found in unfamiliar forms of

collaboration between the various forces that must work in the field when calamity strikes. A

particular area that would benefit from improved methodology and a greater sense of

shared values is the collaboration between health systems and other emergency responders

in the case of mass-casualty events.

In the modern world there are considerable risks of mass casualties caused by

intensified or emerging risks, such as the following:-

• epidemics or pandemics of SARS or avian influenza

• terrorist attacks with mass casualties (bombs or shootings)

• non-conventional CBRN terrorism with mass contamination or infection

• major impacts of windstorms, floods, landslides and sea surges associated

with intensified climatic phenomena.

To these should be added the ever present risk of major earthquake, tsunami or volcanic

eruption, with possible mass fatalities and widespread injury and entrapment.

This advanced training course is an initiative of several institutions. The first is the

Prevention and Protection Service of Careggi Hospital in Florence, a general medicine and

university health facility and the fourth largest hospital in Italy. The second is CESPRO, the

University of Florence's Centre for the Study of Risk Conditions and Civil Protection, which is

in the process of founding an International Institute for Crisis and Security Studies and is also

based at Careggi Hospital. The Mediterranean partner country institution is Magen David

Adom (MDA), the Israeli national EMS society and member of the International Federation of

Red Cross and Red Crescent Societies. MDA is one of the premier organisations for

emergency medical response and has extensive international connections that reflect its

reputation as a leading source of expertise on crisis and disaster response. MDA has vast

experience, in preparing for and responding to multi-casualty incidents, especially those

caused by terrorism. Its response is closely co-ordinated with other responding agencies,

with respect to the preparedness phase as well as the emergency period. MDA also has

great experience in preparing for mass toxicological incidents.

The course will develop comparative methodologies designed to improve the

collaboration between health systems and other emergency services when responding to

sudden catastrophic events that have the potential to result in mass casualties. We see the

connection between health systems and emergency services as a possible weak link during

emergency situations and methodology needs to be disseminated that will help strengthen

it, with the specific aim of ensuring that health needs are efficiently tackled during the

period of crisis.

The key words in this process are integration, interconnection and inter-operability.

These concepts require a shared culture and language of civil protection, with a specific

emphasis on mass casualty management. For full international implementation, they also

require the propagation of training concepts and methods in a wide variety of different

countries.

There are several additional imperatives. First, experiences (for example in Madrid,

March 2004 and London, July 2005) show that terrorist outrages are capable of causing

damage to all vital systems in the human body and hence that medical aid has to be brought

to the scene of the incident in increasingly sophisticated and timely forms. This has created,

not only a medical logistics imperative, but also a pressing need for efficiency in the

collaboration between the various emergency services.

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Secondly, a European pandemic would have profound consequences, not merely for

health and the maintenance of safe conditions in medical facilities, but also for all forms of

social participation, which would greatly complicate the emergency response, and possibly

reduce its efficiency.

Thirdly, a major natural disaster could lead to complex and widespread demands for

search, rescue and field-based medical care that would require a higher order of

organisation than that applied in smaller disasters.

Finally, any form of radioactive leak or CBRN contamination could lead to lasting

consequences for environmental health, which would be added to possible mass casualties

and the difficulty of managing these in a contaminated environment.

In synthesis, the operating circumstances in a major European disaster could be

complex, challenging and replete with demands for integration.

The process of providing a concerted approach to such events will require integration

vertically between levels of government and their associated services, and horizontally

between difference forces and agencies. For example, in the case of terrorist incidents,

intelligence services and the forces of order must work closely with medical and health

protection agencies.

The advanced training course will be structured around the following themes:-

• Description and analysis of best practice in the provision of medical, sanitary

and health care in the wake of sudden-impact disasters, crises and incidents,

with special focus on abrupt natural disasters (including the effects of climate

change), epidemics and terrorism of the conventional or CBRN kinds.

• Discussion of common principles for the efficient integration of medical and

non-medical forces in the response to mass-casualty incidents in Europe.

• Debate and exploration of the potential for improved response to such

incidents.

• Discussion of how to involve stakeholders in the improvement of emergency

management, and how to strengthen international participation in disaster

response.

The following are some of the topics that will be addressed:-

• on-scene procedures of medical providers at the site of the incident or

disaster (triage and treatment), co-ordination with other responding agencies,

and co-ordination with admitting hospitals

• emergencies within hospitals (fire, flood, structural damage, contamination,

facilities overwhelmed, etc.)

• integration of the medical response system between and among medical

centres and field response units

• integration of emergency response between health systems and hospitals, on

the one hand, and the non-medical components (fire brigades, volunteer

rescuers, technical services, transportation systems, emergency planners,

etc.)

• efficient use of advance medical posts (first aid posts) and field hospitals in

major incidents and disasters

• development of new procedures for dealing with the health and medical

aspects of emerging risks (epidemics, CBRN incidents, climate-change effects,

etc.)

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• efficient surveillance and monitoring of epidemiological conditions in major

disasters

• improvement of plans and procedures for dealing with mass fatalities

• improved cross-border collaboration for medical emergencies

• integration of military assistance to civil authorities (MACA) and military

assistance to civilian communities (MACC) with civilian emergency response

• integration of international organisations (e.g. the Red Cross) into the

response to major emergencies.

David Alexander, Chaim Rafalowski

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